Does glucosamine help with arthritic pain?

Glucosamine is a naturally occurring amino sugar that is found in the human body and is involved in the formation and repair of cartilage, particularly within joints. As a supplement, it is most commonly used by individuals with osteoarthritis in the hope that it can slow cartilage breakdown, improve joint function, and reduce pain. It is often sold as glucosamine sulfate or glucosamine hydrochloride, sometimes combined with chondroitin sulfate, another compound found in cartilage.

How is glucosamine thought to work (theoretical mechanism)?

The proposed mechanisms (mostly based on laboratory and animal studies, not strong human evidence) include:

• Serving as a building block for glycosaminoglycans, which are components of cartilage
• Potentially stimulating cartilage repair or slowing breakdown
• Possible anti-inflammatory effects within the joint
• Reducing activity of enzymes that degrade cartilage (e.g., matrix metalloproteinases)

However, it is important to note that these mechanisms are largely theoretical in humans, and the clinical effect in real-world trials has been uncertain.

Study

The GAIT (Glucosamine/Chondroitin Arthritis Intervention Trial) was a large, high-quality clinical trial funded by the U.S. National Institutes of Health (NIH). It was designed to rigorously test whether glucosamine, chondroitin sulfate, or their combination could reduce pain and improve function in patients with knee osteoarthritis. It is considered the gold standard study on this topic!

What it included:

• Randomized, double-blind, placebo-controlled trial
• Total participants: 1,583 patients with knee osteoarthritis
• Duration: 24 weeks
• Treatment groups:
  • Glucosamine hydrochloride (1500 mg/day)
  • Chondroitin sulfate (1200 mg/day)
  • Combination of both
  • Celecoxib (NSAID active control)
  • Placebo
• Primary outcome: ≥20% reduction in knee pain

The inclusion of celecoxib was important because it acted as a benchmark to confirm the trial could detect real treatment effects if they existed.

Results:

Primary outcomes

• No statistically significant difference between placebo and:
  • Glucosamine alone
  • Chondroitin alone
  • Glucosamine + chondroitin

Active control

• Celecoxib showed a clear and statistically significant reduction in pain compared to placebo
• This confirmed the study design was sensitive enough to detect true analgesic effects
• In other words- it glucosamine + chondroitin was going to work, the study would have shown it!

Subgroup analysis

• In patients with moderate-to-severe baseline pain:
  • Combination glucosamine + chondroitin showed a higher response rate than placebo
• This effect was:
  • Not consistent across all analyses
  • Considered hypothesis worth studying more, but definitely not definitive

Secondary outcomes

• No meaningful or consistent improvement in:
  • Physical function
  • Joint stiffness
  • Overall osteoarthritis symptom scores

Safety outcomes

• Glucosamine and chondroitin were generally:
  • Well tolerated
  • Similar adverse event rates compared to placebo
• No major safety concerns identified

Practical Applications 

In the end, this study showed that despite biologically plausible mechanisms, glucosamine (with or without chondroitin) did not provide meaningful clinical benefit for most patients with knee osteoarthritis.

While there was a possible signal of benefit in a subgroup with more severe pain, this was not strong or consistent enough to change overall conclusions. Celecoxib’s positive results supported the validity of the trial design, strengthening confidence in the negative findings for glucosamine.

In the end it’s safe to try glucosamine, but go in knowing that you will likely not see any change, and if you do notice a change, it’s very likely identical to what a placebo would provide.

Stress fractures 101!

By. Dr Sean Delanghe BSc (Hons), DC

There’s nothing worse than hearing you have a stress fracture as a runner (maybe)! This 2024 review of systematic review will help to arm you with the information you need to avoid them and catch them early!

What This Study Is About
Stress fractures are overuse injuries that develop when repeated mechanical loading exceeds the bone’s ability to recover. The paper explores how frequently these injuries occur, where they are most likely to happen, what contributes to their development, and how they are best diagnosed and treated.

How the Research Was Done
The authors reviewed evidence from major databases – primarily systematic reviews. Around 90 studies were initially identified, with approximately 57 included in the final analysis. This is the best of the best!

Where Stress Fractures Happen Most
Stress fractures occur predominantly in the lower extremities due to repetitive loading during running. In long-distance runners, the tibia is the most commonly affected bone, followed by the metatarsals. In contrast, sprinters tend to experience more stress fractures in the toe bones, likely due to the higher forces and forefoot loading associated with sprinting mechanics.

Why Stress Fractures Develop
Stress fractures are multifactorial and typically result from a combination of biological, nutritional, mechanical, and psychological factors.

Key factors include:

• female sex
• reduced bone density
• nutritional factors such as low energy availability and deficiencies in calcium or vitamin
• Training-related issues, particularly rapid increases in workload
• In addition, psychological factors like high stress levels, perfectionism, and fear of failure may indirectly increase injury risk by influencing training behaviours and recovery.

How They Are Diagnosed
Diagnosis begins with a detailed clinical history and physical examination, but imaging is often required for confirmation.

• MRI is considered the most sensitive and preferred method for detecting stress fractures, especially in the early stages.
• X-rays are commonly used but may not detect early bone stress injuries, which can delay diagnosis if relied upon alone.
• Bone scans are the fastest and most sensitive option for most of us in Canada.

What Treatment Looks Like
Treatment primarily involves reducing or temporarily stopping the activity that caused the injury, allowing the bone time to heal. A gradual return to running is introduced once symptoms improve. Importantly, treatment should also address the underlying factors that contributed to the injury- see above!

How to Reduce Your Risk
Preventing stress fractures requires a proactive approach that includes maintaining adequate nutrition and energy availability, progressing training loads gradually, and addressing any biomechanical inefficiencies. Screening for conditions such as RED-S or the Female Athlete Triad may also be important in certain populations. Psychological stress should not be overlooked, as it can influence both training habits and recovery- are you doing the right thing for your training, or are you responding to anxiety that is telling you to illogically ramp up?

Practical applications:

• Most stress fractures occur in the lower extremities
• Tibia is the most common site in long-distance runners
• Metatarsals are the second most common
• Sprinters more commonly experience stress fractures in the toes
• Risk factors include biological, nutritional, mechanical, and psychological components
• MRI is the most sensitive diagnostic tool, bone scan is probably our best choice in Canada
• Treatment focuses on rest, gradual return, and addressing underlying causes
• Prevention requires proper training progression, nutrition, and overall load management
• Managing anxiety related to training and racing is a huge factor for most competitive runners!

If you have any questions about any of your injures for our Waterloo based chiropractors, physios or RMTs- feel free to contact us or book online HERE.

Does Dry Needling help with Plantar Fasciitis?

This article examined whether dry needling (DN) is effective for treating plantar fasciitis (PF), a common cause of heel pain. Dry needling involves inserting thin needles into muscle trigger points wth a goal reduce pain and improve movement.

This is not meant to replace more important strategies like load management, strengthening/ rehab etc. But is it actually a useful adjunct to these better supported potions?

Methods

The authors conducted a systematic review and meta-analysis of previously published research.

Major research databases were searched (PubMed, Embase, Web of Science, etc.), and only randomized controlled trials (RCTs) were included.

Study sample

• 12 RCTs
• 781 total participants
• Comparisons included:
  • Dry needling plus routine care (stretching, massage, exercise)
  • Dry needling alone
  • Other conservative treatments without dry needling

Key Findings

Pain Reduction

Dry needling combined with routine treatment resulted in significantly lower heel pain compared to routine treatment alone. Pain was measured using standard tools such as the Visual Analog Scale (VAS) and Numeric Pain Rating Scale (NPRS).

Mean pain score reduction ranged from −1.76 to −2.12 points, which represents a moderate to large clinically meaningful improvement.

Dry needling alone was not consistently superior to other conservative treatments for pain relief- so you still have to do the other stuff!

Functional Improvement

Dry needling combined with routine care led to significant improvements in foot function (measured with the Foot Function Index), and dry needling alone also showed better functional outcomes than other conservative treatments. This suggests dry needling may improve a patient’s ability to walk, stand, and perform daily activities, even when pain reduction is limited.

Timing of Benefits

Improvements were more consistent after one month. Short-term results (less than one month) were mixed, suggesting dry needling is more effective as a medium-term intervention rather than an immediate solution.

Safety and Side Effects

About 50% of the included studies reported minor side effects, most commonly temporary soreness, mild bruising, or minor bleeding at the needle site. No serious adverse events were reported.

Overall Conclusion

Dry needling appears to be a safe and effective treatment option for plantar fasciitis, particularly when combined with routine conservative care, used for at least one month, and aimed at improving both pain and foot function. However, the authors note that study quality varied, sample sizes were relatively small, and more high-quality randomized controlled trials are needed before strong clinical recommendations can be made.

If you have more questions about this therapy, or would like to try it, please contact us or book online HERE!